How to Avoid Fatty Liver Disease

In the documentary Supersize Me, Morgan Spurlock eats exclusively at McDonald’s for a month and predictably his weight, blood pressure, and cholesterol go up, but so do his liver enzymes, a sign his liver cells are dying and spilling their contents into the bloodstream. His one-man experiment was actually formally replicated. A group of men and women agreed to eat two fast food meals a day for a month. Most of their liver values started out normal, but, within just one week, most were out of whack, a profound pathological elevation in liver damage.

What’s happening is non-alcoholic fatty liver disease (NAFLD), the next global epidemic, as I discuss in my video How to Prevent Non-Alcoholic Fatty Liver Disease. Fatty deposits in the liver result in a disease spectrum from asymptomatic fat buildup to non-alcoholic steatohepatitis (NASH), which can lead to liver scarring and cirrhosis, and may result in liver cancer, liver failure, and death.

NAFLD is now the most common cause of chronic liver disease in the United States, affecting 70 million Americans, nearly one in three adults. Fast food consumption is a great way to bring it on, since it’s associated with the intake of soft drinks and meat. Drinking one can of soda a day may raise the odds of NAFLD by 45 percent, and those eating the equivalent of 14 chicken nuggets’ worth of meat a day have nearly triple the rates of fatty liver compared to those eating 7 nuggets or less.

It’s been characterized as a tale of fat and sugar, but evidently not all types of fat are culpable. Those with fatty hepatitis were found to have eaten more animal fat and cholesterol, and less plant fat, fiber, and antioxidants. This may explain why adherence to a Mediterranean-style diet, characterized by high consumption of foods such as fruits, vegetables, whole grains, and beans, is associated with less severe non-alcoholic fatty liver disease. It could also be related to the presence of specific phytonutrients, like the purple, red, and blue anthocyanin pigments found in berries, grapes, plums, red cabbage, red onions, and radicchio. These anthocyanin-rich foods may be promising for the prevention of fatty liver, but that’s mostly based on petri dish experiments. There was one clinical trial that found that drinking a purple sweet potato beverage seemed to successfully dampen liver inflammation.

A more plant-based diet may also improve our microbiome, the good bacteria in our gut. “‘We are what we eat’ is the old adage but the modern version might be ‘we are what our bacteria eat.’” When we eat fat, we may facilitate the growth of bad bacteria, which can release inflammatory molecules that increase the leakiness of our gut and contribute to fatty liver disease.

Fatty liver disease can also be caused by cholesterol overload. The thought is that dietary cholesterol found in eggs, meat, and dairy oxidizes and then upregulates liver X receptor alpha, which can upregulate something else called SREBP, which can increase the level of fat in the liver. Cholesterol crystals alone cause human white blood cells to spill out inflammatory compounds, just like uric acid crystals in gout. That’s what may be triggering the progression of fatty liver into serious hepatitis: “the accumulation of sufficient concentrations of free cholesterol within steatotic hepatocytes [fatty liver cells] to cause crystallization of the cholesterol.” This is one of several recent lines of evidence suggesting that dietary cholesterol plays an important role in the development of fatty hepatitis—that is, fatty liver inflammation.

In a study of 9,000 American adults followed for 13 years, researchers found a strong association between dietary cholesterol intake and hospitalization and death from cirrhosis and liver cancer, as dietary cholesterol can oxidize and cause toxic and carcinogenic effects. To limit the toxicity of excess cholesterol derived from the diet, the liver tries to rid itself of cholesterol by dumping it into the bloodstream. So, by measuring the non-HDL cholesterol in the blood, one can predict the onset of fatty liver disease. If we subtract HDL from total cholesterol, none of the hundreds of subjects followed with a value under 130 developed the disease. Drug companies view non-alcoholic fatty liver disease as a bonanza, “as is the case of any disease of affluence…considering its already high and rising prevalence and…[its] needing continuous pharmacologic treatment,” but maybe avoiding it is as easy as changing our diet, avoiding sugary and cholesterol-laden foods.

“The unpalatable truth is that NAFLD could almost be considered the human equivalent of foie gras (loosely translated from French as ‘fat liver’). As we overeat and ‘force-feed’ ourselves foods that can result in serious health implications, however, having such a buttery texture in human livers is not a delicacy to be enjoyed by hepatologists [liver doctors] in clinical practice!”

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

87 responses to “How to Avoid Fatty Liver Disease”

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I appreciate the fact that many people in Venezuela are suffering horribly. However, that is not what the main thrust of the interview on NPR was. It was merely that queso was not available to purchase. The person being interviewed did not mention that he was starving, he mentioned being upset that he had to resort to lentils for his arepas stuffing, something that he mentioned he thought he would never do.

Deb, your friend’s comment about watching out for the liver probably has to do with the lectins in beans. Paleo people tend to propagate this as a major concern. Many of them believe beans are toxic because of lectins. Of course, we know the concern is way out of context. We also know that many more common and beneficial foods besides beans contain lectins. Making sure beans are cooked before eating them will eliminate most lectin content. And who would be inclined to eat them raw anyway? Except for a remote possibility of beans made into meals and flours, I doubt it’s much of a risk for raw beans to get into anyone’s diet.

You always add to the discussions and have a clarity to your written voice. I would not have guessed 80’s, though I watched an interview with a vegan doctor who was still performing surgery into his mid-90’s and I think there is a man in his 90’s playing recreational hockey with young people. Can’t remember if that was 80’s or 90’s, but the heart doctor was definitely in his 90’s.

I have a few relatives about to turn 90. I also have relatives and a friend in their 60’s who end up in the hospital every other week.

Thanks very much for the compliment, Deb. If I said I am in my 80’s, I must have been dreaming it. I am in my 60’s. Did I somehow mistype that when I was chatting with YR a day or two ago? Anyway, age is really just a number, as you have nicely illustrated. I feel for your friend and relative in my age range with all their hospitalizations. You have given me a good reminder to count my blessings, so thanks for that too!

My deepest sympathies with anyone suffering from the economic and refugee crisis in Venezuela.That said, the Cuban experience following the collapse of the Soviet Union, when meat/lard imports from the Soviet block ceased and most worked on community gardens, offers a sense of the likely health effects.

The crisis reduced per capita daily energy intake from 2,899 calories to 1,863 calories. During the crisis period, the proportion of physically active adults increased from 30% to 67%, and a 1.5-unit shift in the body mass index distribution was observed, along with a change in the distribution of body mass index categories. The prevalence of obesity declined from 14% to 7%, the prevalence of overweight increased 1%, and the prevalence of normal weight increased 4%. During 1997–2002, there were declines in deaths attributed to diabetes (51%), coronary heart disease (35%), stroke (20%), and all causes (18%).

The same thing happened in Eastern Europe when communism collapsed there.

The authors of this study on heart disease mortality in Poland concluded that most of the benefits werre due to decreased intake of saturated fats and their replacement by unsaturated fats, and to increased cosumption of fresh fruits and vegetables.

The association between higher protein and cholesterol consumption and increased rates of NAFLD, and the inverse association between carbohydrate consumption and NAFLD, makes one wonder if the low carb fad of the last two or three decades might have played a role in the increasing prevalence of this disease.

The human body also contains significant amounts of phosphorous but consuming too much of it si toxic.

This argument that because a substance is naturally found in the human body, it is safe to consume large amounts of it in the diet is often used by eg the pro-cholesterol and saturated fat types. They have to use facile arguments like this because the evidence overwhelmingly shows that consuming large amounts of those substances increases mortality and morbidity risk.

The body makes its own fats/oils except for two specific types, LA and ALA. Those have to be obtained from the diet. They can be obtained from green leafy vegetables, nuts and seeds.

Oils aren’t necessary. Nor am I aware that there is any good evidence that liberal consumption of nut and vegetable oils is safe. Given the evidence about the effects of oil consumption on endothelial function, I’d suggest that prudence might be warranted.https://nutritionfacts.org/video/olive-oil-and-artery-function/

Note though that Dr G recommends supplementing with small amounts of algal oil for brain health.

Even WFPB types argue about using a little oil with their meals. Miles from Healthy Crazy Cool is pro-olive oil (and he has beautiful skin), for example.

All these “rules”! I don’t cook with oil (saute with just water), but I do put a few squirts of EVOO on my one slice of Ezekiel toast, and if no avocado with my raw salad at dinner time, I’ll drizzle a couple of drops there too.

Navy Corpsman, you are right that plant cell membranes contain oils — as do ours. Plant cells also contain proteins (enzymes and structural) and carbohydrates — lots of carbohydrates, especially in cell walls (which our cells don’t have). And seeds (which includes nuts) have high amounts of storage carbohydrates, oils, and proteins for use by the germinating plant.

I think the problem is processed food: refined carbohydrates (sugars and flours), refined oils, and I would include refined proteins (pea protein, etc). Eating whole foods avoids these, and not using them or using them sparingly to add to your foods is a good idea.

Since seeds have concentrated storage depots of carbohydrates, and oils, it’s good to eat them in moderation. However, they also contain storage depots of protein, so they are a good source of protein. The idea is to maximize protein intake (and carbohydrate intake which is often fiber) while minimizing oil intake. Thus, eat your beans and grains. And eat seeds — which includes nuts — in moderation, since their relative proportion of fat to protein is higher.

To confuse the situation: Beans and whole grains are also seeds. Botanically speaking. LOL!! But they are in different categories nutritionally, or for cooking purposes. As a botanist, I find it somewhat confusing.

So I say: Eat lots of veggies and fruits, legumes (beans, lentils, and chickpeas) and whole grains, and seeds and nuts in moderation. But not speaking botanically.

Mitch, some of us watch these videos on our lunch break at work. I really don’t need to see a fatty liver floating in fat while I have my lentils & brown rice with broccoli, red & green peppers, eggplant, zucchini, mixed steamed greens, flavored with fennel seeds, oregano, basil, thyme, rosemary & sage & held together with roasted red pepper hummus. Thank you very much. It’s bad enough to see what other people eat in this office complex. Let alone what it might be doing to their various body parts.

Hi Nancy,
I did not want to sugar coat the effect of a poor diet on the liver. I’ve worked in hospitals for over 40 years and I’ve seen first hand what the SAD can do to a body.
I guess I should put in a disclaimer the next time I get a bit too “real” with my info..
My apologies…
mitch

Abstract Nonalcoholic fatty liver disease is an increasingly
common condition that may progress to hepatic cirrhosis.
This pilot study evaluated the effects of a low-carbohydrate,
ketogenic diet on obesity-associated fatty liver disease. Five
patients with a mean body mass index of 36.4 kg/m2 and
biopsy evidence of fatty liver disease were instructed to
follow the diet (<20 g/d of carbohydrate) with nutritional
supplementation for 6 months. Patients returned for group
meetings biweekly for 3months, then monthly for the second
3 months. The mean weight change was −12.8 kg (range 0
to −25.9 kg). Four of 5 posttreatment liver biopsies showed
histologic improvements in steatosis (P=.02) inflammatory
grade (P=.02), and fibrosis (P=.07). Six months of a low-carbohydrate,
ketogenic diet led to significant weight loss
and histologic improvement of fatty liver disease. Further
research is into this approach is warranted.

My mother died from non-alcoholic fatty liver disease in 2015 at the age of 73. We did not learn that she had scarring (cirrhosis) until a 2013 emergency room visit for a different issue. It progressed rapidly from there.

We had never heard of fatty liver disease before and were stunned with her diagnosis of cirrhosis. She *never* drank. No alcohol. Not even a little wine. She also rarely ate meat of any form. She ate pork on occasion, but, other than that, she was basically vegetarian, although not vegan.

She was raised very poor in the southern Alabama area in the 1940s. No indoor plumbing. No electricity. Holes in her clothing. And the kids only got to eat what was left after the adults ate–since the adults needed the energy to work in the fields. This upbringing caused her not only to raise us with excess but to eat in excess herself when she was an adult.

Her and my father did well and their financial means allowed her to eat whatever she wanted. She was famous for her cooking and loved to bake. Her biggest problems were sweets and a sedentary lifestyle. Besides partaking in the desserts she often baked, she also ate chocolate in excess. When she was in her 40s she would sit down with a bag of Hershey’s kisses and eat the whole thing. She was overweight by about 50 lbs and simply refused to exercise. The extent of her activity was walking when shopping.

If I were to use only her as a model for what causes fatty liver disease, it would be overeating, sugar, and lack of physical activity. For her, neither meat nor alcohol played a role.

Now, what do you do if you have fatty liver? I was diagnosed with fatty liver in 2014, and all I was told then was to go plant based (I had 2 weeks before the diagnosis) and to lose weight. I have been trying to lose weight since then and I have managed to lose and keep off 50 lbs but I can’t seem to lose more and I still have fatty liver. Is there anything more I can do?

It’s Doug Lisle, psychologist who gives great talks plant based diet and on the difficulties some people have, and why. That one is about reaching a plateau and what to do about it.

Most of the plant base docs do not advocate added fats like oils or spreads. Plant foods (oatmeal has 15% fat for example) contain sufficient fat. I do not eat avocados, nuts (1 walnut per day), coconut or oils at all and I am not trying to lose weight, just preventing weight gain. I had to adjust my caloric intake downwards to prevent weight gain in my case. Anyway, check out the video and others by Doug Lisle. Dr Greger has a huge selection of videos dedicated to losing weight… just type it in the search bar. All the best to you!

Emily, I have two suggestions that could help you, and the first one is the easiest in every way:

1. – Search the internet for Chef AJ, whose focus is whole plant food weight-loss. Her communication media is mostly videos and there are a lot of her videos, but they are hosted at different sites so you really have to search.

She teaches about using whole plant foods to overcome food addiction and losing weight by focusing on calorie density (which is not the same thing as counting calories).

2. – My other suggestion is Macrobiotics, which tends to be the choice of last resort when folks are facing serious illness, but the Macrobiotic diet will heal the body when you diligently follow the diet. Cheating will prevent you from reaching your health goal. I’ll try to explain it in a simple way:

Macrobiotics is more selective about individual foods and how they are prepared than other whole plant food diets. Macrobiotic theory is that the body can heal itself when you feed it the foods that are the easiest to digest, and certain vegetables and fruit require more energy to digest than others.

When you remove the difficult to digest foods from your diet, the body uses that newly available energy (which it previously used to digest food) to work on healing itself. It’s not deprivation, it’s eating foods which require less energy to digest …without any exceptions.

Macrobiotics is a fast way to heal your body, but it’s strict because it is impossible to heal by eating MOSTLY Macrobiotic. However, you can MAINTAIN good health on a MOSTLY Macrobiotic diet.

“Studies have shown that coffee drinkers with fatty liver disease have less liver damage than those who don’t drink this caffeinated beverage. Caffeine appears to lower the amount of abnormal liver enzymes of people at risk for liver diseases.”

Good question: coffee and tea seem to have a protective role, preventing fibrosis (scar) formation. But researchers believe more study is needed. Of course, sugar and/or cream added to the coffee would not help fatty liver. https://www.ncbi.nlm.nih.gov/pubmed/27060021

Similar to Emily D, I too was diagnosed with fatty liver. A gastroenterologist told me that for a large majority of people with NAFLD, liver function is normal but a simple ultrasound will show islands of fatty tissue dispersed throughout the liver. He too mentioned weight loss and diet change will reverse it but I have been doing this and when I do have the ultrasound done, the signs of fatty liver are still there. I’ve been vegan for 3 years, so absolutely no meat. I don’t really have processed sweets and my fat consumption is limited to nuts/seeds or natural fats found in foods such as avocados, and no oils. I’ve always heard about the regenerative powers of the liver. Anyone have any advice on reversing NAFLD?

Not sure where to post this…The Paleo and anti-WFPB crowd has posted in a couple of places now that the reason Morgan Spurlock’s liver enzymes were abnormal was because he was still drinking while he conducted his experiment. There is no evidence for that, but that has never stopped the let-me-eat-whatever-junk-I-want crowd before. Their lies and denial can get quite brazen, and their only tactic seems to be to discredit any evidence that what they are eating is harmful. So obvious.

“Choline was once believed to be a dispensable nutrient because there is a pathway for endogenous formation of phosphatidylcholine catalyzed by phosphatidylethanolamine N-methyltransferase (PEMT). However, controlled clinical feeding studies demonstrated unequivocally that choline is an essential nutrient; humans deprived of choline developed either fatty liver and liver cell death or developed skeletal muscle damage [1, 2]. These findings were reinforced by clinical evidence that patients fed with total parenteral nutrition solutions low in choline developed fatty liver and liver damage [28].”

There are many plant sources of choline (chickpeas) but the strongest one is from lecithin

“The supply of lecithin without exercise led to a significant increase of the plasma choline concentrations, on average by 26.9% (P < or = 0.01). In trial II, when running without a supply of lecithin, the mean plasma choline concentrations in the adolescent runners remained stable which may have been due to the duration of the physical stress.."

To Anyone:
Where can I find studies against the Keto diet. I, like almost all that visit this site, am already WFPB. So there are times I just want to get info on a specific dietary need without doing hours of research. For instance I wanted to read Dr. T Colin Campbell’s book “The Low Carb Fraud”. and I see sites debunking it like this, link below.

As an observer, such as i, it seems that keto supporters nake just as good of arguments. That is why people like me are left confused. There seem to be a lot of biased websites….and when crowds say “we are 100% right and ypu are 100% wrong” it makes natvigating truth difficult. Sent from my Samsung Galaxy , an AT&T LTE smartphone

Hi, Charles! A whole foods plant-based diet is very effective for both preventing and treating non-alcoholic fatty liver disease. This is an eating pattern that is composed of fruits, vegetables, whole grains, and legumes; and devoid of animal products and processed foods. As stated above, it’s also best to avoid soda as just one can a day may raise the odds of NAFLD by 45 percent. The reduction in animal fat and dietary cholesterol and the addition of more fiber and antioxidants has many benefits, one being a reduction in fatty liver disease (https://nutritionfacts.org/video/metabolic-syndrome-and-plant-based-diets/). A whole foods plant-based diet is also very effective for achieving a healthy weight. Even just losing weight will likely help you out with your symptoms.

I’ve been plant based since reading ‘the China Study’ in 2013; to see raw flesh of an animal that was bred and raised for what we know to be not intended for our nutrition is repulsive.
At 65, I’m seeking to share even more of what I believe most know is the high road. We are not here to proliferate and consume another species. We must take the steps needed to educate those we are blessed with knowing; it’s a calling.

My partner died of NASH at the way-too-young age of 71. He had a weight problem his entire life and ate a lot of animal products and high-fat snack foods. I got him to eat more veggie meals, at least at home, in his last years, but I guess it was too late to make a difference. In the end, he could barely eat anything at all.